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Cultural Diversity Issues Cultural Diversity Issues in Education and Practicein Education and Practice
Nataliya LishchenkoNataliya Lishchenko
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull We All Have ItWe All Have It
bull Obvious ManifestationsObvious Manifestationsndash ReligionReligionndash Ethnicity (Race)Ethnicity (Race)ndash National Origin (language)National Origin (language)ndash GenderGender
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull Less Obvious ManifestationsLess Obvious Manifestationsndash AgeAgendash EducationEducationndash Educational StatusEducational Statusndash Mobility (including handicaps)Mobility (including handicaps)
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull What is CultureWhat is Culture Definition the sum total of the way of Definition the sum total of the way of
living includes values beliefs living includes values beliefs standards language thinking patterns standards language thinking patterns behavioral norms communications behavioral norms communications styles etc Guides decisions and styles etc Guides decisions and actions of a group through timeactions of a group through time
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull Expressions of Culture in Health CareExpressions of Culture in Health Care
ndash Health Belief SystemsHealth Belief Systems
bullDefine and categorize health and illnessDefine and categorize health and illnessbullOffer explanatory models for illnessOffer explanatory models for illnessbullBased upon theories of the relationship between Based upon theories of the relationship between
cause and the nature of illness and treatmentscause and the nature of illness and treatmentsbullDefines the specific ldquoscoperdquo of practice for healersDefines the specific ldquoscoperdquo of practice for healers
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull The Culture of Western MedicineThe Culture of Western Medicinendash Meliorism ndash make it betterMeliorism ndash make it betterndash Dominance over nature ndash take controlDominance over nature ndash take controlndash Activism ndash do somethingActivism ndash do somethingndash Timeliness ndash sooner than laterTimeliness ndash sooner than laterndash Therapeutic aggressiveness ndash stronger=betterTherapeutic aggressiveness ndash stronger=betterndash Future orientation ndash plan newer=betterFuture orientation ndash plan newer=betterndash Standardization ndash treat similar the sameStandardization ndash treat similar the same
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull ldquoldquoOursrdquoOursrdquondash Make it BetterMake it Betterndash Control Over NatureControl Over Naturendash Do SomethingDo Somethingndash Intervene NowIntervene Nowndash Strong MeasuresStrong Measuresndash Plan Ahead ndash Plan Ahead ndash
Recent is BestRecent is Bestndash Standardize ndash Treat Standardize ndash Treat
Everyone the SameEveryone the Same
bull ldquoldquoOthersrdquoOthersrdquondash Accept With GraceAccept With Gracendash BalanceHarmony with BalanceHarmony with
NatureNaturendash Wait and SeeWait and Seendash Cautious DeliberationCautious Deliberationndash Gentle ApproachGentle Approachndash Take Life As It Comes ndash Take Life As It Comes ndash
ldquoTime HonoredrdquoldquoTime Honoredrdquondash Individualize ndash Individualize ndash
Recognize DifferencesRecognize Differences
Growing Diversity in America
During the Past 20 years
bull 1048708 White population increased 10
bull 1048708 African American population increased 30
bull 1048708 Native American population increased 58
bull 1048708 Hispanic population increased 125
Diversity Demographics for theyear 2000
bull Whites 70
bull 1048708 Hispanic 13
bull 1048708 African Am 12
bull 1048708 Asian 4
bull 1048708 N Am 1
Projected Demographics for2030
bull White 60
bull 1048708 Hispanic 19
bull 1048708 Black 13
bull 1048708 AsianPI 7
bull 1048708 N AmAk N 1
In CaliforniaIn California
Population of 38 Million
bull 13 of the population is of Hispanic origin
bull Over 10 Asian
bull Over 4 more than one race
bull Nearly 17 identify as ldquoOther racerdquo
In CaliforniaIn California
bull1 in 4 are foreign born 37 of these entered the US after 1990
bull Nearly 40 of the population over the age of 5 speaks a language other than English at home
bull Over 25 of the population is under the age of 18
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull We All Have ItWe All Have It
bull Obvious ManifestationsObvious Manifestationsndash ReligionReligionndash Ethnicity (Race)Ethnicity (Race)ndash National Origin (language)National Origin (language)ndash GenderGender
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull Less Obvious ManifestationsLess Obvious Manifestationsndash AgeAgendash EducationEducationndash Educational StatusEducational Statusndash Mobility (including handicaps)Mobility (including handicaps)
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull What is CultureWhat is Culture Definition the sum total of the way of Definition the sum total of the way of
living includes values beliefs living includes values beliefs standards language thinking patterns standards language thinking patterns behavioral norms communications behavioral norms communications styles etc Guides decisions and styles etc Guides decisions and actions of a group through timeactions of a group through time
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull Expressions of Culture in Health CareExpressions of Culture in Health Care
ndash Health Belief SystemsHealth Belief Systems
bullDefine and categorize health and illnessDefine and categorize health and illnessbullOffer explanatory models for illnessOffer explanatory models for illnessbullBased upon theories of the relationship between Based upon theories of the relationship between
cause and the nature of illness and treatmentscause and the nature of illness and treatmentsbullDefines the specific ldquoscoperdquo of practice for healersDefines the specific ldquoscoperdquo of practice for healers
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull The Culture of Western MedicineThe Culture of Western Medicinendash Meliorism ndash make it betterMeliorism ndash make it betterndash Dominance over nature ndash take controlDominance over nature ndash take controlndash Activism ndash do somethingActivism ndash do somethingndash Timeliness ndash sooner than laterTimeliness ndash sooner than laterndash Therapeutic aggressiveness ndash stronger=betterTherapeutic aggressiveness ndash stronger=betterndash Future orientation ndash plan newer=betterFuture orientation ndash plan newer=betterndash Standardization ndash treat similar the sameStandardization ndash treat similar the same
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull ldquoldquoOursrdquoOursrdquondash Make it BetterMake it Betterndash Control Over NatureControl Over Naturendash Do SomethingDo Somethingndash Intervene NowIntervene Nowndash Strong MeasuresStrong Measuresndash Plan Ahead ndash Plan Ahead ndash
Recent is BestRecent is Bestndash Standardize ndash Treat Standardize ndash Treat
Everyone the SameEveryone the Same
bull ldquoldquoOthersrdquoOthersrdquondash Accept With GraceAccept With Gracendash BalanceHarmony with BalanceHarmony with
NatureNaturendash Wait and SeeWait and Seendash Cautious DeliberationCautious Deliberationndash Gentle ApproachGentle Approachndash Take Life As It Comes ndash Take Life As It Comes ndash
ldquoTime HonoredrdquoldquoTime Honoredrdquondash Individualize ndash Individualize ndash
Recognize DifferencesRecognize Differences
Growing Diversity in America
During the Past 20 years
bull 1048708 White population increased 10
bull 1048708 African American population increased 30
bull 1048708 Native American population increased 58
bull 1048708 Hispanic population increased 125
Diversity Demographics for theyear 2000
bull Whites 70
bull 1048708 Hispanic 13
bull 1048708 African Am 12
bull 1048708 Asian 4
bull 1048708 N Am 1
Projected Demographics for2030
bull White 60
bull 1048708 Hispanic 19
bull 1048708 Black 13
bull 1048708 AsianPI 7
bull 1048708 N AmAk N 1
In CaliforniaIn California
Population of 38 Million
bull 13 of the population is of Hispanic origin
bull Over 10 Asian
bull Over 4 more than one race
bull Nearly 17 identify as ldquoOther racerdquo
In CaliforniaIn California
bull1 in 4 are foreign born 37 of these entered the US after 1990
bull Nearly 40 of the population over the age of 5 speaks a language other than English at home
bull Over 25 of the population is under the age of 18
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull Less Obvious ManifestationsLess Obvious Manifestationsndash AgeAgendash EducationEducationndash Educational StatusEducational Statusndash Mobility (including handicaps)Mobility (including handicaps)
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull What is CultureWhat is Culture Definition the sum total of the way of Definition the sum total of the way of
living includes values beliefs living includes values beliefs standards language thinking patterns standards language thinking patterns behavioral norms communications behavioral norms communications styles etc Guides decisions and styles etc Guides decisions and actions of a group through timeactions of a group through time
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull Expressions of Culture in Health CareExpressions of Culture in Health Care
ndash Health Belief SystemsHealth Belief Systems
bullDefine and categorize health and illnessDefine and categorize health and illnessbullOffer explanatory models for illnessOffer explanatory models for illnessbullBased upon theories of the relationship between Based upon theories of the relationship between
cause and the nature of illness and treatmentscause and the nature of illness and treatmentsbullDefines the specific ldquoscoperdquo of practice for healersDefines the specific ldquoscoperdquo of practice for healers
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull The Culture of Western MedicineThe Culture of Western Medicinendash Meliorism ndash make it betterMeliorism ndash make it betterndash Dominance over nature ndash take controlDominance over nature ndash take controlndash Activism ndash do somethingActivism ndash do somethingndash Timeliness ndash sooner than laterTimeliness ndash sooner than laterndash Therapeutic aggressiveness ndash stronger=betterTherapeutic aggressiveness ndash stronger=betterndash Future orientation ndash plan newer=betterFuture orientation ndash plan newer=betterndash Standardization ndash treat similar the sameStandardization ndash treat similar the same
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull ldquoldquoOursrdquoOursrdquondash Make it BetterMake it Betterndash Control Over NatureControl Over Naturendash Do SomethingDo Somethingndash Intervene NowIntervene Nowndash Strong MeasuresStrong Measuresndash Plan Ahead ndash Plan Ahead ndash
Recent is BestRecent is Bestndash Standardize ndash Treat Standardize ndash Treat
Everyone the SameEveryone the Same
bull ldquoldquoOthersrdquoOthersrdquondash Accept With GraceAccept With Gracendash BalanceHarmony with BalanceHarmony with
NatureNaturendash Wait and SeeWait and Seendash Cautious DeliberationCautious Deliberationndash Gentle ApproachGentle Approachndash Take Life As It Comes ndash Take Life As It Comes ndash
ldquoTime HonoredrdquoldquoTime Honoredrdquondash Individualize ndash Individualize ndash
Recognize DifferencesRecognize Differences
Growing Diversity in America
During the Past 20 years
bull 1048708 White population increased 10
bull 1048708 African American population increased 30
bull 1048708 Native American population increased 58
bull 1048708 Hispanic population increased 125
Diversity Demographics for theyear 2000
bull Whites 70
bull 1048708 Hispanic 13
bull 1048708 African Am 12
bull 1048708 Asian 4
bull 1048708 N Am 1
Projected Demographics for2030
bull White 60
bull 1048708 Hispanic 19
bull 1048708 Black 13
bull 1048708 AsianPI 7
bull 1048708 N AmAk N 1
In CaliforniaIn California
Population of 38 Million
bull 13 of the population is of Hispanic origin
bull Over 10 Asian
bull Over 4 more than one race
bull Nearly 17 identify as ldquoOther racerdquo
In CaliforniaIn California
bull1 in 4 are foreign born 37 of these entered the US after 1990
bull Nearly 40 of the population over the age of 5 speaks a language other than English at home
bull Over 25 of the population is under the age of 18
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull What is CultureWhat is Culture Definition the sum total of the way of Definition the sum total of the way of
living includes values beliefs living includes values beliefs standards language thinking patterns standards language thinking patterns behavioral norms communications behavioral norms communications styles etc Guides decisions and styles etc Guides decisions and actions of a group through timeactions of a group through time
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull Expressions of Culture in Health CareExpressions of Culture in Health Care
ndash Health Belief SystemsHealth Belief Systems
bullDefine and categorize health and illnessDefine and categorize health and illnessbullOffer explanatory models for illnessOffer explanatory models for illnessbullBased upon theories of the relationship between Based upon theories of the relationship between
cause and the nature of illness and treatmentscause and the nature of illness and treatmentsbullDefines the specific ldquoscoperdquo of practice for healersDefines the specific ldquoscoperdquo of practice for healers
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull The Culture of Western MedicineThe Culture of Western Medicinendash Meliorism ndash make it betterMeliorism ndash make it betterndash Dominance over nature ndash take controlDominance over nature ndash take controlndash Activism ndash do somethingActivism ndash do somethingndash Timeliness ndash sooner than laterTimeliness ndash sooner than laterndash Therapeutic aggressiveness ndash stronger=betterTherapeutic aggressiveness ndash stronger=betterndash Future orientation ndash plan newer=betterFuture orientation ndash plan newer=betterndash Standardization ndash treat similar the sameStandardization ndash treat similar the same
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull ldquoldquoOursrdquoOursrdquondash Make it BetterMake it Betterndash Control Over NatureControl Over Naturendash Do SomethingDo Somethingndash Intervene NowIntervene Nowndash Strong MeasuresStrong Measuresndash Plan Ahead ndash Plan Ahead ndash
Recent is BestRecent is Bestndash Standardize ndash Treat Standardize ndash Treat
Everyone the SameEveryone the Same
bull ldquoldquoOthersrdquoOthersrdquondash Accept With GraceAccept With Gracendash BalanceHarmony with BalanceHarmony with
NatureNaturendash Wait and SeeWait and Seendash Cautious DeliberationCautious Deliberationndash Gentle ApproachGentle Approachndash Take Life As It Comes ndash Take Life As It Comes ndash
ldquoTime HonoredrdquoldquoTime Honoredrdquondash Individualize ndash Individualize ndash
Recognize DifferencesRecognize Differences
Growing Diversity in America
During the Past 20 years
bull 1048708 White population increased 10
bull 1048708 African American population increased 30
bull 1048708 Native American population increased 58
bull 1048708 Hispanic population increased 125
Diversity Demographics for theyear 2000
bull Whites 70
bull 1048708 Hispanic 13
bull 1048708 African Am 12
bull 1048708 Asian 4
bull 1048708 N Am 1
Projected Demographics for2030
bull White 60
bull 1048708 Hispanic 19
bull 1048708 Black 13
bull 1048708 AsianPI 7
bull 1048708 N AmAk N 1
In CaliforniaIn California
Population of 38 Million
bull 13 of the population is of Hispanic origin
bull Over 10 Asian
bull Over 4 more than one race
bull Nearly 17 identify as ldquoOther racerdquo
In CaliforniaIn California
bull1 in 4 are foreign born 37 of these entered the US after 1990
bull Nearly 40 of the population over the age of 5 speaks a language other than English at home
bull Over 25 of the population is under the age of 18
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull Expressions of Culture in Health CareExpressions of Culture in Health Care
ndash Health Belief SystemsHealth Belief Systems
bullDefine and categorize health and illnessDefine and categorize health and illnessbullOffer explanatory models for illnessOffer explanatory models for illnessbullBased upon theories of the relationship between Based upon theories of the relationship between
cause and the nature of illness and treatmentscause and the nature of illness and treatmentsbullDefines the specific ldquoscoperdquo of practice for healersDefines the specific ldquoscoperdquo of practice for healers
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull The Culture of Western MedicineThe Culture of Western Medicinendash Meliorism ndash make it betterMeliorism ndash make it betterndash Dominance over nature ndash take controlDominance over nature ndash take controlndash Activism ndash do somethingActivism ndash do somethingndash Timeliness ndash sooner than laterTimeliness ndash sooner than laterndash Therapeutic aggressiveness ndash stronger=betterTherapeutic aggressiveness ndash stronger=betterndash Future orientation ndash plan newer=betterFuture orientation ndash plan newer=betterndash Standardization ndash treat similar the sameStandardization ndash treat similar the same
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull ldquoldquoOursrdquoOursrdquondash Make it BetterMake it Betterndash Control Over NatureControl Over Naturendash Do SomethingDo Somethingndash Intervene NowIntervene Nowndash Strong MeasuresStrong Measuresndash Plan Ahead ndash Plan Ahead ndash
Recent is BestRecent is Bestndash Standardize ndash Treat Standardize ndash Treat
Everyone the SameEveryone the Same
bull ldquoldquoOthersrdquoOthersrdquondash Accept With GraceAccept With Gracendash BalanceHarmony with BalanceHarmony with
NatureNaturendash Wait and SeeWait and Seendash Cautious DeliberationCautious Deliberationndash Gentle ApproachGentle Approachndash Take Life As It Comes ndash Take Life As It Comes ndash
ldquoTime HonoredrdquoldquoTime Honoredrdquondash Individualize ndash Individualize ndash
Recognize DifferencesRecognize Differences
Growing Diversity in America
During the Past 20 years
bull 1048708 White population increased 10
bull 1048708 African American population increased 30
bull 1048708 Native American population increased 58
bull 1048708 Hispanic population increased 125
Diversity Demographics for theyear 2000
bull Whites 70
bull 1048708 Hispanic 13
bull 1048708 African Am 12
bull 1048708 Asian 4
bull 1048708 N Am 1
Projected Demographics for2030
bull White 60
bull 1048708 Hispanic 19
bull 1048708 Black 13
bull 1048708 AsianPI 7
bull 1048708 N AmAk N 1
In CaliforniaIn California
Population of 38 Million
bull 13 of the population is of Hispanic origin
bull Over 10 Asian
bull Over 4 more than one race
bull Nearly 17 identify as ldquoOther racerdquo
In CaliforniaIn California
bull1 in 4 are foreign born 37 of these entered the US after 1990
bull Nearly 40 of the population over the age of 5 speaks a language other than English at home
bull Over 25 of the population is under the age of 18
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull The Culture of Western MedicineThe Culture of Western Medicinendash Meliorism ndash make it betterMeliorism ndash make it betterndash Dominance over nature ndash take controlDominance over nature ndash take controlndash Activism ndash do somethingActivism ndash do somethingndash Timeliness ndash sooner than laterTimeliness ndash sooner than laterndash Therapeutic aggressiveness ndash stronger=betterTherapeutic aggressiveness ndash stronger=betterndash Future orientation ndash plan newer=betterFuture orientation ndash plan newer=betterndash Standardization ndash treat similar the sameStandardization ndash treat similar the same
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull ldquoldquoOursrdquoOursrdquondash Make it BetterMake it Betterndash Control Over NatureControl Over Naturendash Do SomethingDo Somethingndash Intervene NowIntervene Nowndash Strong MeasuresStrong Measuresndash Plan Ahead ndash Plan Ahead ndash
Recent is BestRecent is Bestndash Standardize ndash Treat Standardize ndash Treat
Everyone the SameEveryone the Same
bull ldquoldquoOthersrdquoOthersrdquondash Accept With GraceAccept With Gracendash BalanceHarmony with BalanceHarmony with
NatureNaturendash Wait and SeeWait and Seendash Cautious DeliberationCautious Deliberationndash Gentle ApproachGentle Approachndash Take Life As It Comes ndash Take Life As It Comes ndash
ldquoTime HonoredrdquoldquoTime Honoredrdquondash Individualize ndash Individualize ndash
Recognize DifferencesRecognize Differences
Growing Diversity in America
During the Past 20 years
bull 1048708 White population increased 10
bull 1048708 African American population increased 30
bull 1048708 Native American population increased 58
bull 1048708 Hispanic population increased 125
Diversity Demographics for theyear 2000
bull Whites 70
bull 1048708 Hispanic 13
bull 1048708 African Am 12
bull 1048708 Asian 4
bull 1048708 N Am 1
Projected Demographics for2030
bull White 60
bull 1048708 Hispanic 19
bull 1048708 Black 13
bull 1048708 AsianPI 7
bull 1048708 N AmAk N 1
In CaliforniaIn California
Population of 38 Million
bull 13 of the population is of Hispanic origin
bull Over 10 Asian
bull Over 4 more than one race
bull Nearly 17 identify as ldquoOther racerdquo
In CaliforniaIn California
bull1 in 4 are foreign born 37 of these entered the US after 1990
bull Nearly 40 of the population over the age of 5 speaks a language other than English at home
bull Over 25 of the population is under the age of 18
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Cultural Diversity and Health Cultural Diversity and Health CareCare
bull ldquoldquoOursrdquoOursrdquondash Make it BetterMake it Betterndash Control Over NatureControl Over Naturendash Do SomethingDo Somethingndash Intervene NowIntervene Nowndash Strong MeasuresStrong Measuresndash Plan Ahead ndash Plan Ahead ndash
Recent is BestRecent is Bestndash Standardize ndash Treat Standardize ndash Treat
Everyone the SameEveryone the Same
bull ldquoldquoOthersrdquoOthersrdquondash Accept With GraceAccept With Gracendash BalanceHarmony with BalanceHarmony with
NatureNaturendash Wait and SeeWait and Seendash Cautious DeliberationCautious Deliberationndash Gentle ApproachGentle Approachndash Take Life As It Comes ndash Take Life As It Comes ndash
ldquoTime HonoredrdquoldquoTime Honoredrdquondash Individualize ndash Individualize ndash
Recognize DifferencesRecognize Differences
Growing Diversity in America
During the Past 20 years
bull 1048708 White population increased 10
bull 1048708 African American population increased 30
bull 1048708 Native American population increased 58
bull 1048708 Hispanic population increased 125
Diversity Demographics for theyear 2000
bull Whites 70
bull 1048708 Hispanic 13
bull 1048708 African Am 12
bull 1048708 Asian 4
bull 1048708 N Am 1
Projected Demographics for2030
bull White 60
bull 1048708 Hispanic 19
bull 1048708 Black 13
bull 1048708 AsianPI 7
bull 1048708 N AmAk N 1
In CaliforniaIn California
Population of 38 Million
bull 13 of the population is of Hispanic origin
bull Over 10 Asian
bull Over 4 more than one race
bull Nearly 17 identify as ldquoOther racerdquo
In CaliforniaIn California
bull1 in 4 are foreign born 37 of these entered the US after 1990
bull Nearly 40 of the population over the age of 5 speaks a language other than English at home
bull Over 25 of the population is under the age of 18
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Growing Diversity in America
During the Past 20 years
bull 1048708 White population increased 10
bull 1048708 African American population increased 30
bull 1048708 Native American population increased 58
bull 1048708 Hispanic population increased 125
Diversity Demographics for theyear 2000
bull Whites 70
bull 1048708 Hispanic 13
bull 1048708 African Am 12
bull 1048708 Asian 4
bull 1048708 N Am 1
Projected Demographics for2030
bull White 60
bull 1048708 Hispanic 19
bull 1048708 Black 13
bull 1048708 AsianPI 7
bull 1048708 N AmAk N 1
In CaliforniaIn California
Population of 38 Million
bull 13 of the population is of Hispanic origin
bull Over 10 Asian
bull Over 4 more than one race
bull Nearly 17 identify as ldquoOther racerdquo
In CaliforniaIn California
bull1 in 4 are foreign born 37 of these entered the US after 1990
bull Nearly 40 of the population over the age of 5 speaks a language other than English at home
bull Over 25 of the population is under the age of 18
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Diversity Demographics for theyear 2000
bull Whites 70
bull 1048708 Hispanic 13
bull 1048708 African Am 12
bull 1048708 Asian 4
bull 1048708 N Am 1
Projected Demographics for2030
bull White 60
bull 1048708 Hispanic 19
bull 1048708 Black 13
bull 1048708 AsianPI 7
bull 1048708 N AmAk N 1
In CaliforniaIn California
Population of 38 Million
bull 13 of the population is of Hispanic origin
bull Over 10 Asian
bull Over 4 more than one race
bull Nearly 17 identify as ldquoOther racerdquo
In CaliforniaIn California
bull1 in 4 are foreign born 37 of these entered the US after 1990
bull Nearly 40 of the population over the age of 5 speaks a language other than English at home
bull Over 25 of the population is under the age of 18
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Projected Demographics for2030
bull White 60
bull 1048708 Hispanic 19
bull 1048708 Black 13
bull 1048708 AsianPI 7
bull 1048708 N AmAk N 1
In CaliforniaIn California
Population of 38 Million
bull 13 of the population is of Hispanic origin
bull Over 10 Asian
bull Over 4 more than one race
bull Nearly 17 identify as ldquoOther racerdquo
In CaliforniaIn California
bull1 in 4 are foreign born 37 of these entered the US after 1990
bull Nearly 40 of the population over the age of 5 speaks a language other than English at home
bull Over 25 of the population is under the age of 18
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
In CaliforniaIn California
Population of 38 Million
bull 13 of the population is of Hispanic origin
bull Over 10 Asian
bull Over 4 more than one race
bull Nearly 17 identify as ldquoOther racerdquo
In CaliforniaIn California
bull1 in 4 are foreign born 37 of these entered the US after 1990
bull Nearly 40 of the population over the age of 5 speaks a language other than English at home
bull Over 25 of the population is under the age of 18
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
In CaliforniaIn California
bull1 in 4 are foreign born 37 of these entered the US after 1990
bull Nearly 40 of the population over the age of 5 speaks a language other than English at home
bull Over 25 of the population is under the age of 18
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Diversity related facts
bull The population is becoming increasingly diverse
bull 1048708 underrepresented groups make up approximately 30 of the population
bull 1048708 Health care workforce has not kept up with the changing demographics
bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce
bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Ethnic Health Disparities
African Americans
bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US
bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Ethnic Health Disparities
Native Americans
bull1048708 2-3 times more likely to have diabetes mellitus that the general population
bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Reports of Disparities in HealthCare
Disparities in health care do existand are associated with higher
mortality among minorities
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Reported Racial and EthnicDisparities in Healthcare
Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites
Blacks are also more frequently labeled as psychotic
(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)
Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given
appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer
Minorities are less likely to receive kidney dialysis or transplants
Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal
environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to
memebers of the health care teammemebers of the health care team
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention
bull Family planning and family systemsFamily planning and family systems
bull Health and wellnessHealth and wellness
bull Lifestyle choicesLifestyle choices
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity
bull Coping mechanismsCoping mechanisms
bull Religious and spiritual influences on Religious and spiritual influences on healthhealth
bull Support systemsSupport systems
bull End of lifeEnd of life
bull Therapeutic interventionsTherapeutic interventions
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity
bull Basic care and comfort practiciesBasic care and comfort practicies
bull Nutritional preferencesNutritional preferences
bull Therapeutical proceduresTherapeutical procedures
bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Dietary PreferencesDietary Preferences
African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage
in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Dietary PreferencesDietary Preferences
European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Dietary PreferencesDietary Preferences
American Indians EskimosAmerican Indians Eskimos
bull Blue cornmealBlue cornmeal
bull FishFish
bull GameGame
bull Fruits and berriesFruits and berries
bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Religion and Dietary Religion and Dietary PracticiesPracticies
Roman CatholicsRoman Catholics
bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday
bull Optional fasting during lent seasonOptional fasting during lent season
bull During Lent discourage meat on During Lent discourage meat on FridayFriday
bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Religion and Dietary Religion and Dietary PracticiesPracticies
Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)
bull Alcohol prohibitedAlcohol prohibited
bull Limited consumption of meatLimited consumption of meat
bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism
bull Beaf and veal prohibitedBeaf and veal prohibited
bull Many individuals are vegetariansMany individuals are vegetarians
bull Limited consumption of meatLimited consumption of meat
bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship
bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting
bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually
slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of
Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Religion and Dietary Religion and Dietary PracticiesPracticies
Jehovahrsquos WitnessJehovahrsquos Witness
bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added
bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black
EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean
agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as
being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very
importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask
personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
African-AmericansAfrican-Americans
Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present
than the futurethan the future2 Close personal space is 2 Close personal space is
importantimportant3 Touching anothers hair is 3 Touching anothers hair is
sometimes viewed as offensivesometimes viewed as offensive
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
African-AmericansAfrican-Americans
Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are
importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed
householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with
community iscommunity isimportantimportant
5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
African-AmericansAfrican-Americans
Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that
may bemay becaused by demons or spiritscaused by demons or spirits
4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
African-AmericansAfrican-Americans
Health risks Health risks
1 Sickle cell anemia1 Sickle cell anemia
2 Hypertension2 Hypertension
3 Coronary heart disease3 Coronary heart disease
4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)
5 Lactose intolerance5 Lactose intolerance
6 Coccidioidomycosis6 Coccidioidomycosis
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
African-AmericansAfrican-Americans
Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an
unacceptableunacceptableform of languageform of language
3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior
4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare
5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted
before an individual seeks medical treatmentbefore an individual seeks medical treatment
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Asian AmericansAsian Americans
CommunicationCommunication
1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English
2 Silence is valued2 Silence is valued
3 Eye contact is considered rude3 Eye contact is considered rude
4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally
5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement
6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Asian AmericansAsian Americans
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Social distance is important2 Social distance is important
3 Usually do not touch others during conversation3 Usually do not touch others during conversation
4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex
5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore
touching someone on the head is disrespectfultouching someone on the head is disrespectful
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Asian AmericansAsian Americans
Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and
honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are
expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam
Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Asian AmericansAsian Americans
Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony
with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)
2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and
yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold
foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness
5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Asian AmericansAsian Americans
Health risksHealth risks
1 Hypertension1 Hypertension
2 Cancer (stomach 2 Cancer (stomach and liver)and liver)
3 Lactose intolerance3 Lactose intolerance
4 Thalassemia4 Thalassemia
5 Coccidioidomycosis5 Coccidioidomycosis
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Asian AmericansAsian Americans
ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch
a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so
2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual
seeks out traditional treatmentseeks out traditional treatment
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Hispanic-AmericanHispanic-American
Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various
dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is
importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil
eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child
4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of
negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial
expressions is used to express emotion or painexpressions is used to express emotion or pain
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Hispanic-AmericanHispanic-American
Time orientation and spaceTime orientation and space
1 Oriented more to present1 Oriented more to present
2 Comfortable with close proximity to others2 Comfortable with close proximity to others
3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes
4 Value the physical presence of others4 Value the physical presence of others
5 Politeness and modesty are essential5 Politeness and modesty are essential
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Hispanic-AmericanHispanic-American
Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large
extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family
members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women
are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Hispanic-AmericanHispanic-American
Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of
good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-
tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces
3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins
4 Folk medicine traditions4 Folk medicine traditions
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Hispanic-AmericanHispanic-American
Health risksHealth risks
1 Lactose intolerance1 Lactose intolerance
2 Diabetes mellitus2 Diabetes mellitus
3 Parasites3 Parasites
4 Coccidioidomycosis4 Coccidioidomycosis
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Hispanic-AmericanHispanic-American
ImplementationImplementation
1 Communicate with male head of family1 Communicate with male head of family
2 Protect privacy2 Protect privacy
3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of
the significance of religious practices related tothe significance of religious practices related to
illnessesillnesses
4 Always touch a child when examining him or her4 Always touch a child when examining him or her
5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Native AmericansNative Americans
CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other
tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect
others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of
disrespectdisrespect5 Body language is important5 Body language is important
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Native AmericansNative Americans
Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand
during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to
promote bonding between infant and promote bonding between infant and mothermother
55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Native AmericansNative Americans
Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes
people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the
mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Native AmericansNative Americans
Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the
person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces
and disequilibrium between person and and disequilibrium between person and environmentenvironment
33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition
44 Traditional healer medicine man or Traditional healer medicine man or womanwoman
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Native AmericansNative Americans
Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Native AmericansNative Americans
ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even
when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which
health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital
66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
PROLONGATION OF LIFEPROLONGATION OF LIFE
AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife
BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-
aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews
BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims
CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy
DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths
EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Try your knowledgeTry your knowledge
A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment
1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate
1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding
2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care
3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client
4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that
1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products
is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special
Cultural Diversity and Health Cultural Diversity and Health CareCare
It is because we are different It is because we are different that each of us is specialthat each of us is special