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1 million immigrants come to the U.S.each year (U.S. INS, 1991).
More than half are women of
childbearing age (U.S. INS, 1991). 1 in every 1 !ersons in the United
States is foreign"born (National #enter for#$lt$ral #om!etence, 1999).
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AfricanAmerican--12.1%
Hispanic--11.5%
Asian/PacificIslander--3.8%
AmericanIndian/AlaskaNative--0.7%
Nn-Hispanic
!"ite--71.#%(Population Estimates and
Projections, 2000)
American Indian/
Alaska Native
Asian/Pacific
Islander
Hispanic
African
American
NonHispanic
!"ite
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%roviding services, s$!!orts andassistance&
'hat are res!onsive to beliefs, inter!ersonal
styles, attit$des, lang$age and behaviors ofindivid$als with the greatest lielihood ofens$ring maim$m acce!tance and!artici!ation
'hat demonstrate res!ect for individ$al
dignity, !ersonal !reference and c$lt$raldi*erences
(#evelopmental #isa$ilities and %ill of &i'"ts Act of 2000)
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U.S. demogra!hics are changing.
+ealth dis!arities eist between ethnicgro$!s in the United States.
eg$latory mandates re-$ireincreased, doc$mented c$lt$ralcom!etence.
#$lt$ral com!etence enriches!rofessional n$rsing !ractice.
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#$lt$re is a distinct way of life thatcharacteries a !artic$lar comm$nityof !eo!le.
#$lt$re incl$des shared !ractices,beliefs, val$es and c$stoms !assedthro$gh generations.
#$lt$re !rovides a sense of identity
(/I belong0).
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al$es
2orld view
3isease etiology
'ime orientation
%ersonal s!ace
4amily organiation
%ower str$ct$re
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Integration into mainstream c$lt$re
5*ected by age at time of arrival in anew setting, reason for moving to a
new setting and residence in a!redominantly ethnic neighborhood
6enerally taes three generations inthe United States (S!ector, 7)
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8thnocentrism is the belief that onesown c$lt$re is best.
%roviders m$st be mindf$l of their own
ethnocentrism.
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8mic !ers!ective:;f an insider ormember of the c$lt$re
8tic !ers!ective:;f an o$tsider or
observer of the c$lt$re
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5 f$nctional tradition enhances anindivid$als health and well"being.
5 ne$tral tradition neither enhances
nor harms an individ$als health andwell"being.
5 non"f$nctional tradition is !otentiallyharmf$l to an individ$al.
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Individ$al vs. gro$! identity
3ecision"maing
8ye contact
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8vil s!irits
4athers !artici!ation at birth
Male health care !roviders
%regnancy as a healthy, nat$ral state
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From USDA & DHHS, 2002
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5frican 5merican:Sicle cell disease
5mish:%=U, hemo!hilia <
6ree:'halassemia
>ewish:'ay"sachs, 6a$chers disease
Native 5merican:'y!e 7 diabetesmellit$s
Note: Conditions not limited to a single populationgroup.
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#ommon !ractices 5voiding !eo!le from other c$lt$res
ef$sing to recognie c$lt$ral di*erences
ecogniing di*erences, b$t feeling ownway is s$!erior (ethnocentrism)
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2here were yo$born?
+ow long have yo$lived in the UnitedStates?
2ho are yo$r ma@ors$!!ort !eo!le?
2hat lang$ages do
yo$ s!ea and read?
2hat are yo$rreligio$s !ractices?
2hat are yo$r food
!references? 2hat is yo$r
economicsit$ation?
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2hat doeschildbearingre!resent to yo$?
+ow do yo$ viewchildbearing?
5re there anymaternal !reca$tionsor restrictions?
Is birth a !rivate orsocial e!erience?
+ow wo$ld yo$ lieto manage labor!ain?
2ho will !rovidelabor s$!!ort?
2ho will care forthe baby?
3o yo$ $secontrace!tion?
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Use a conversational a!!roach.
5s o!en"ended -$estions.
Integrate c$lt$ral and childbearing
assessments. Aisten with interest.
emain non@$dgmental.
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Inter!reters comm$nicate verbally. Sho$ld be female
Sho$ld not be a family member
'ranslators wor with written comm$nication.
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Maintain strict conBdentiality.
Inter!ret everything the woman sayswitho$t editorialiing or !ara!hrasing.
8ither !arty may interr$!t or seeadditional information.
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6ro$! needs vs. individ$al needs
ef$sal of treatment
Informed consent
'r$thf$lness
Morality