TRANSCULTURAL NURSING (NUR 4001)

By:
Christopher Ekpo

INFLUENCE OF CULTURE ON PATIENT CARE

Culture
.There is no single definition.
.The sum total of socially inherited
characteristics of a human group that
comprises everything which one
generation can tell, convey or hand down
to the next
( Fejos in Spector, 2009).

Culture
.The sum of the beliefs, practices, habits,
likes, dislikes, norms, customs, rituals and
so forth that we learned from our families
during the years of socialization
( Spector, 2009).

Culture
An image of the culture of India:
Courtesy, sscnet.ucla.edu
http://www.sscnet.ucla.edu/southasia/Culture/culture.jpg

Culture
.The thoughts, communications, actions,
customs, beliefs, values and institutions of
racial, ethnic, religious or social groups
(Office of minority health, 2001).

Culture
.A model of the manifestation of culture at
different levels of depth
http://www.tamu.edu/faculty/choudhury/culture/culture1.jpg

Culture
.A collective programming of the mind
that distinguishes the members of one
group or category of people from
another.
.The sum of total of the learned behaviour
of a group of people that are generally
considered to be the tradition of that
people and are transmitted from
generation to generation.

Culture
Artistic display of Jamaican culture:
Courtesy, jamaica-vacations.net
http://www.jamaica-vacations.net/culture.jpg

Culture
.A culture is a way of life of a group of
people--the behaviours, beliefs, values,
and symbols that they accept, generally
without thinking about them and that are
passed along by communication and
imitation from one generation to the next.

Culture
Sports especially athletics is part of
Jamaican culture: Courtesy, jamaican.com
http://www.jamaicans.com/bm~pix/jamaica-culture~s600x600.jpg

Culture
Dancehall music is part of Jamaican
culture: Courtesy, parisdj.com
http://www.djouls.com/souljazz/images/Various-Dancehall_The_Rise_Of_Jamaican_Cul
ture_b.jpg

.Patient s beliefs and response to health

Patient s beliefs and response to health

.Professional health care must be
developed to be culturally sensitive,
culturally appropriate and culturally
competent.
.This is necessary to meet the complexculture bound health needs of a given
person, family and community.

Patient s beliefs and response to health

.Transcultural nursing provides nursing
care across cultural boundaries.
.Takes into account the context in which
the patient lives as well as the situations
in which the patient s health problems
arise.

Patient s beliefs and response to health

Culturally competent care:
.The nurse must understand and attend to
the total context of the patient s situation
and this is a complex combination of
knowledge, attitudes and skills.

Patient s beliefs and response to health

Culturally appropriate care:
.The nurse must apply the underlying
background knowledge that must be
possessed to provide a patient with the
best possible nursing/health care.

Patient s beliefs and response to health

Beliefs influence a patient s response to
health: Courtesy,allworldreligion.com
http://allworldreligion.com/userfiles/2010/4/15/images/Religion%20at%20work%20%2
0A%20growing%20number%20of%20discrimination%20cases%20center%20on%20employees%20
beliefs.jpg

Patient s beliefs and response to health

Culturally sensitive care:
.The nurse must possess some basic
knowledge of and constructive attitudes
toward the health/health traditions
observed among the diverse cultural
groups found in the setting in which he or
she is practicing.

Patient s beliefs and response to health

.Our beliefs and expectations are very
powerful.
.Our beliefs can either improve our health
or damage it.
.Beliefs cause behaviour that affects
physical health.
.Beliefs cause endocrine and immune
changes.

Patient s beliefs and response to health

.The placebo effect describes how a
substance with no medical properties
causes a patient to improve, just because
they believe in its efficacy.
.Certain cultures have beliefs similar to
the placebo effects.

.Level of education and response to health

Level of education and response to health

.There is a well known, large and
persistent association between education
and health
.This has been observed in many
countries and time periods and for a
wide variety of health measures
.The differences between the more and
the less educated are significant
(Cutler & Lleras-Muney, 2011).

Level of education and response to health

.The more educated report having lower
morbidity from the most common acute
and chronic diseases (heart condition,
stroke, hypertension, emphysema,
diabetes, asthma attacks, ulcer).

Level of education and response to health

Level of education influences response to
health: Image courtesy,
talentsearchsparc.org
http://www.talentsearchsparc.org/images/happinesscake.gif

Level of education and response to health

.More educated people are less likely to
be hypertensive or to suffer from
emphysema or diabetes.
.Physical and mental functioning is also
better for the better educated.

Level of education and response to health

.The better educated are substantially
less likely to report that they are in poor
health, and less likely to report anxiety or
depression.
.Finally, better educated people report
spending fewer days in bed or not at
work because of disease, and usually
have fewer functional limitations.

Level of education and response to health

.Those with more years of schooling are
less likely to smoke, to drink heavily, to
be overweight or obese, or to use illegal
drugs.
.Interestingly, the better educated report
having tried illegal drugs more
frequently, but they gave them up more
readily.

.Economic status and response to health

Economic status and response to health

.A large body of evidence indicates that
socioeconomic status (SES) is a strong
predictor of health.
.Better health is associated with having
more income, more years of education,
and a more prestigious job, as well as
living in neighbourhoods where a higher
percentage or residents have higher
incomes and more education.

Economic status and response to health

There are multiple pathways by which SES
may affect health, including:
.Access and quality of health care,
.Health-related behaviours,
.Individual psychosocial processes, and
.Physical and social environments.

Economic status and response to health

Morbidity rate by socioeconomicstatus,
courtesy, annualreviews.org
http://www.annualreviews.org/na101/home/literatum/publisher/ar/journals/content/
psych/2011/psych.2011.62.issue-1/annurev.psych.031809.130711/production/images/m
edium/ps620501.f1.gif

Economic status and response to health

SES gradients can be seen in pre-disease
indicators such as;
.Blood pressure,
.Cortisol patterns,
.Central adiposity, and
.Carotid atherosclerosis. This may reflect
the wear and tear on the body of
exposure to stressors and lifestyle factors
associated with lower SES

Economic status and response to health

.Socioeconomically disadvantaged men
and women have higher overall mortality
rates than persons with higher
socioeconomic status
.Relationships between class and
mortality are consistent for almost every
cause of death, with only a few
exceptions, notably certain cancers
(Berkman & Epstein, 2008).

Economic status and response to health

.Poorer children may be more likely to
suffer from chronic conditions such as
asthma, epilepsy, or heart conditions
that lead to poorer health status
.In addition, their families may be less
able to provide the investments
necessary to maintain good health status
in the presence of a chronic condition
(Case, Lubotsky & Paxson, 2002).

Economic status and response to health

.People with access to wealth, knowledge,
and power have the means to take
advantage of all the relevant health
information available in any specific
place or at any given time
(Phelan & Link, 2003).

.Cultural norms and response to health

Cultural norms and response to health

.Cultural norms are the shared,
sanctioned, and integrated systems of
beliefs and practices that characterize a
cultural group.
.They are passed from one generation to
the other.

Cultural norms and response to health

.As prescriptions for correct and moral
behaviour, cultural norms lend meaning
and coherence to life, as well as the
means to achieve a sense of integrity,
safety and belonging.

Cultural norms and response to health

.Normative beliefs(norms), together with
related values and rituals, confer a sense
of order and control upon aspects of life
that might otherwise appear chaotic or
unpredictable.

Cultural norms and response to health

.Cultural norms are woven into
interpretations and expressions of health
and illness through dynamic, interactive
relationships at all levels of influence
from the gene to the society.

Cultural norms and response to health

Cultural norms often mediate the
relationship between ethnicity and
health, even effecting gene expression
through such practices as;
.Marriage rules,
.Lifestyle choices, and
.Environmental exposures.

Cultural norms and response to health

At the individual and group levels, cultural
norms have a substantial role in healthrelated behaviours such as;
.Dietary practices,
.Tobacco use, and
.Exercise.
.Conversely, health can influence cultural
norms (ask students to give examples)

Cultural norms and response to health

.Cultural systems, as adaptive tools,
change in response to external cues, as
evident in the transmutations that occur
in norms as diverse groups interact and
influence one another.
.Practices are also adapted to new
environments as a response to
immigration or technology.

References
Berkman, L. &Epstein, A. (2008).
Beyond Health Care-Socioeconomic
Status and Health. Retrieved from:
http://www.nejm.org/doi/full/10.1056/NEJMe0802773

References
Case, A; Lubotsky, D. & Paxson, C. (2002).
Economic status and health in childhood:
the origins of the gradient.
Retrieved from:
http://www.princeton.edu/rpds/papers/pdfs/casepaxsoneconomicstatuspaper.pdf

References
Cutler, D. & Lleras-Muney, A. (2011).
Education and Health: Evaluating
Theories and Evidence. Retrieved from:
http://www.nber.org/digest/mar07/w12352.html

References
Phelan, J. & Link, B. (2003). When Income
Affects Outcome:Socioeconomic
Status and Health.
Retrieved from:
http://www.investigatorawards.org/downloads/researchinprofilesiss06feb2003.pdf

References