Transcultural Nursing and Developmental Milestone Nations of Origin Communication Space Time Orientation Social Organization Environmental Control

Biological Variations Asian * China * Hawaii * Philippines * Korea * Japan * Southeast Asia * (Laos, Cambodia, Vietnam) * National language preference * Dialects, written characters * Use of silence * Nonverbal and contextual cuing * Noncontact people * Present * Family:hierarchical structure, loyalty * Devotion to tradition * Many religions, including Taoism, Buddhism, Islam, and Christianity * Community Social Organizations * Traditional health and illness beliefs * Use of traditional medicines * Traditional practitioners: Chinese doctors and herbalists * Liver cancer * Stomach cancer * Coccidioidomycosis * Hypertension * Lactose intolerance Africa * West coast (as slave) * Many African countries * West Indian Islands * Domnican republic * Haiti * Jamaica * National languages * Dialect: pidgin, creole, Spanish, and French * Close personal space * Present over future * Family: many female, single parent * Large, extended family networks * Strong church affiliation within community

* Community social organizations * Traditional health and illness beliefs * Folk medicine tradition * Traditional health: rootworker * Sickle cell anemia * Hypertension * Cancer of the esophagus * Stomach cancer * Coccidioidomycosis * Lactose intolerance Europe * Germany * England * Italy * Ireland * Other European Countries * National languages * Many learn English immediately * Nonontact people * Aloof * Distant * Southern countries: closer contact and touch * Future over present * Nuclear families * Extended families * Judeo-Christian religions * Community social organizations * Primary reliance on modern health care system * Traditional health and illness beliefs * Some remaining folk medicine traditions * Breast cancer * Heart disease * Diabetes mellitus * Thalassemia * American Indian * 500 American Indian tribes * Aleuts * Eskimos * Tribal languages * Use of silence and body language * Space very important and has no boundaries * Present * Extremely family oriented * Biological and extended families

* Children taught to respect traditions * Community social organizations * Traditional health and illness beliefs * Folk medicine tradition * Traditional healer: medicine man * Accidents * Heart disease * Cirrhosis of the liver * Diabetes mellitus Hispanic countries * Soain * Cuba * Mexico * Central and South America * Spanish or Portuguese primary language * Tactile relationships: * Touch * Handshakes * Embracing * Value of physical presence * Present * Nuclear family * Extened families * Compadrozzo; godparents * Community social organizations * Traditional health and illness beliefs * Folk medicine tradition * Traditional healers: curandero, espiritista, partera, senora * Diabetes mellitus * Parasites * Coccidioidomycosis * Lactose intolerance Cultural Group Cultural Variations (common belief/practices) Nursing Implications African-Americans Dialect and slang terms require careful communication to prevent error (e.g., bad may mean good) Question the clients meaning or intent Mexican Americans Eye behavior is important. An individual who looks at and admires a child without touching the child has given the child the evil eye. Always touch the child you are examining or admiring American Indians Eye contact is a sign of disrespect and is thus avoided Recognize that the

client may be attentive and interested even though eye contact is avoided Appalachians Eye contact is considered impolite or a sign of hostility. Verbal pattern may be confusing. Avoid excessive eye contact. Clarify statements. American Eskimos Body language is very important. The individual seldom disagrees publicly with others. Client may nod yes to yes to be polite, even if not in agreement. Monitor own body language l\closely as well as clients to detect meaning. Jewish Americans Orthodox Jews consider excess touching, particularly from members of the opposite sex, offensive. Establish whether client is an Orthodox Jew and avoid excessive touch. Chinese Americans Individual may nod head to indicate yes or shake head to indicate no. Excessive eye contact indicates rudeness. Excessive touch is offensive Ask questions carefully and clarify responses. Avoid excessive eye contact and touch. Filipino Americans Offending people is to be avoided at all cost. Nonverbal behavior is very important. Monitor nonverbal behaviors of self and client, being sensitive to physical and emotional discomfort or concerns of the client. Haitain Americans Touch is used in conversation. Direct eye contact is used to gain attention and respect during communication. Use direct eye contact when communicating. East Indian Hindu Americans Women avoid eye contact as a sign of respect. Be aware that men may view eye contact by women as offensive. Avoid eye contact. Vietnamese Americans Avoidance of eye contact is a sign of respect. The head is considered sacred; it is not polite to pat the head. An upturned palm is offensive in communication. Limit eye contact. Touch the hand only when mandated and explain clearly before proceeding to do so. Avoid hand gesturing. Important Definitions: 1. Culture: is a patterned behavioral response that develops over time through social and religious customs and intellectual and artistic activities; a result of acquired mechanisms that may have innate influences but are primarily affected by internal and external environmental stimuli. 2. Cultural values: unique, individual expressions of a particular culture that have been accepted as appropriate over time. They guide actions and decision making that facilitate self-worth and self-esteem.

3. Cultural behavior: how a person acts in certain situations, is socially acquired, not genetically inherited. 4. Transcultural Nursing: is viewed as a culturally competent practice field that is client centered and research focused. Every individual is culturally unique, and nurses are no exception. Therefore, nurses must use caution to avoid projecting their own cultural uniqueness and world views on the client if culturally appropriate care is to be provided. 5. Ethnicity: is frequently, and perhaps incorrectly, used to mean race. The term ethnicity includes more than biological identification. Ethnicity in its broadest sense refers to groups of whose members share a common social and cultural heritage that is passed on to successive generations. The most important characteristic of ethnicity is that members of an ethnic group feel a sense of identity. 6. Race: in contrast to ethnicity, race is related to biology. Member of particular group share distinguishing physical features such as skin color, bone structure, or blood group. 7. Ethnocentrism: Looking at the world from their own particular cultural viewpoint. 8. Stereotyping: is the assumption that all people in a similar cultural, racial, or ethnic group are alike and share the same values and beliefs. A excellent example of stereotyping is an African-American nurse being assigned to care from an African-American client simply because of ethnicity and race.